Deidre' Marie Clark, MA, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

3698 Issued in MN

Practice address

200 4TH Ave W Ste 300
Shakopee, MN 55379-1220

Phone

(952) 496-8445

NPI assigned

Jan 12, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Behavioral Health Advocacy Services LLC

  • Adult Mental Health Clinic/Center
  • Saint Cloud, MN
  • NPI 1558929539
  Medicare reassignment NPD
• Lakeview Behavioral Health Inc.

  • Community/Behavioral Health Agency
  • Grand Rapids, MN
  • NPI 1154404325
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1245829548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 RIVER WOODS LN",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553373369",
            "telephone_number": "952-220-0263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 4TH AVE W STE 300",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553791220",
            "telephone_number": "952-496-8445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "DEIDRE'",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "MA, LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-12",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "3698",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Christenson
• Kristine K Christenson, PHD, LP
• Cities Dentistry, PA
• Caitlin Claggett
• Michael J Clairmont, RPH
• Sarah Lynn Clark, FNP
• Brian C Clarkowski, MD
• Clarkson Optometry, Inc (Clarkson Eyecare)
• Benjamin Clements, RN
• Lara T Collins Asmus, L.M.F.T.

• Marriage & Family Therapist in Shakopee, MN
• Providers in Shakopee, MN by specialty
• Marriage & Family Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.